RealMental

Ami asks: I have been bipolar since the mid 80’s, probably before that.  At the age of 46, I started taking medication for it.  Before meds, I guess you could call it ‘what a long, strange trip it’s been’. 

My question is this:  What about cognitive dysfunction?  Why doesn’t the side effect sheet say point blank “If you take this medication, your memory will go south to retire”?  “You will not be able to think straight” is another one I can think of.  If I had known my memory and mind would have fallen apart like it has, I sure would have done things differently. 

The only mood stabilizer I’ve ever been able to tolerate is Lamictal.  Now my liver is acting up, and I have to go back soon for more blood-work, nothing conclusive yet.  I took antidepressants for four years now. 

My quality of life is suffering, along with everything
else since I started meds. 

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I was talking to my therapist about various things during our last session, and one of them was how much better I feel for having started writing again.  She knows that I blog and that I keep my journal.  I’m not sure if she reads my personal blog or this one– I suppose telling her about them keeps me honest.  I was also showing her a poetry series that I was working on, since some of it had to do with other things we were talking about.  She handed my journal back to me and said something simple but perspective-altering– “what a relief to recover something you used to do for pleasure.”

When I think of how many pink cloth diaries and wire-bound notebooks and scratch pads I used to fill with bad poetry, stories, rantings to myself, and every other musing, prosaic and poetic when I was an adolescent and teen… all I can say is I did it because I enjoyed it.  It gave me relief.  I wasn’t sharing what I wrote (and it was before the internet, anyway) or expecting criticism– I just wrote for my Self.  And I just . . . stopped, lost that part of myself with my first really bad depression in college.  I didn’t recover my writing in any consistent fashion until after my diagnosis in 2005.

I’ve always let peter out things I really enjoyed when I entered a bad depression.  As depression’s lead blanket would descend, causing me to lose my joy in life, and as my insecurities would foster a deeper depression, I would become convinced I didn’t deserve happiness, and would withdraw from life.  I would withdraw from, or even sabotage friendships.  I would stay in my dark bedroom all day.  I would let the phone ring and ring and ring.  And I would let the thoughts circle around, in ever-tightening spirals in my mind, until it was impossible to break out of the vortex until my brain chemistry righted itself.  But now, I know more about the whys and hows of my depression, and am slowly getting better about seeing the black cloud on the horizon.  I know now that if I allow myself to back away from all the things I enjoy, then it’ll be worse than if I just grit my teeth and at least go through the motions. The activity itself is therapeutic.  So now, I resolve to do the things I used to do for pleasure, whether I feel like it or not.  I think that “practice makes perfect” has especial meaning when depression is keeping you pinned to your bed.

Write every day, for the release, for getting the circling thoughts out of my head.  Get out in the sunshine every day, because the secret to bipolars is that we are all part plant and part cat, and need sunshine to stay sane.  Meditate every day and do yoga three times a week, so I can let go of some of the circling thoughts that don’t really require writing out.  Call a far-away friend once a week, and ask them about what’s going on with them.  Have lunch or dinner with a friend at least once, preferably twice a week, because I have good friends, who care, who make me laugh, who deserve my attention.  And try not to forget the things I like to do for fun, because the only thing better than the relief of recovering that joy is never really having lost it.

I haven’t been to therapy recently and don’t go again for a couple of weeks. Truthfully, I haven’t thought much about my issues lately. I’m not sleeping well or eating much, but it’s not due to sadness or feeling overwhelmed. I’m excited about life these days and can’t wait to start the next day. I lie in bed, awake, thinking about what I can plow through tomorrow.

I’m not eating as much because I’m not binge eating at all. I’m just extremely busy and excited about life. I find when I’m as busy as I am, I don’t think as much or as hard about things as I normally do. Rather I don’t “feel” as much.

I’m really task oriented these days. Making lists, crossing things off and getting things done. I’m outside more. I’m playing with my kids more, spending time with the husband more. I’m finding myself laughing more too. It’s nice. I’m happy.

So much for the January/February slump so many of us find ourselves in.

I seem to be a magnet for friends and family members going through just that. My phone rings off the hook with complaints from others, the blahs, the “I should do a, b, and c” but I don’t wanna….whine whine whine. I’m guilty of that same whining and procrastinating at times but for some reason I’m motivated as heck to get things done. Maybe because I have so much to do in a day that is fun or exciting now, who knows.

“Make a list,” I say to the whiners.

And make a list they do. Once they start crossing things off, they feel better, I hear a day or two later.

In the morning, over coffee, before I start work, I make two lists: one is a running tally of clients and what I hope to accomplish for them for the day; the other is a list for the house/family and what I hope to get done. Sometimes the tasks are as small as putting away a load of laundry or taking the polish off my toenails. Silly little things maybe but nevertheless they have to get done.

Crossing things off wakes me up, makes me feel like I’ve done something. There used to be days where I’d mindlessly surf the internet, sometimes working, sometimes just reading blogs or whatever, and by 3 or 4 in the afternoon, I’d look down and realize I was still in my pajamas and feel ashamed because I hadn’t done anything.

Now I still spend many days in my pajamas, but going off to shower at noon with a notepad full of crossed off tasks is pretty satisfying.

Several years ago I was having a chat with a family member when they asked me about my decision to stop pursuing a career in music- what made me decide to take a more practical route. I told them that it was a hard choice, but that I’d realized that a) I was an okay musician. Not great, but fair- and that fair wasn’t going to cut it, and b) for a long time I thought, melodramatically, that music defined me as a person, that it was the essence of my being. As I got older I realized that music was something that I loved, loved doing, but that whether I played music as a profession or as a hobby I was not going to let it make me feel defeated or unhappy.

My relative looked me straight in the eye and without any conscious ill-intent said, “Well Amanda, you know Allison Krauss isn’t attractive and she has a career in music.”.

Yesterday, the same relative expressed concern that I might one day feel resentful towards my child, “Because she’s so cute and pretty.”.

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I have trained myself to listen to my inner voice and to what it’s saying to me. After about a decade of of awareness and gentle correction I have learned to pay attention to that voice, to be diligent, and ultimately to be kind to myself in thought and action. It has made a world of difference in the way that I live and the way that I feel about myself.

The greatest gift I’ve received from this practice is the realization that the voice in my head, the one that calls me names, tells me I’m not good enough- the one that is so hard and cruel- it’s not my voice. Those thoughts were placed there by other people and for a long time I let other people control the way I feel about myself.

These days, more often than not, the voice is mine. And it thinks I’m more than just okay.

Last week I was asked by a Real Mental reader to write about my decision to continue taking my antidepressants during my pregnancy. I’ve been reluctant to do so but if there was ever a place where I’m safe to write about these issues, it’s here. (Thank you Leah)

My depression was my main concern when my husband and I first decided to try to have a baby. I did a lot of reading and up to the point that I found out I was pregnant, I still hadn’t made a decision. I knew what my gut was telling me though and that was to stay on my medication.

I had two very distinct opinions from the doctors I saw during the first few weeks of my pregnancy. The first doctor I saw was a GP who I saw for the initial “just to be sure” blood test. When I asked him for his opinion about remaining on my antidepressant he was very firmly against it. I tried explaining some of my history to him but he wasn’t receptive- which was fine, it wasn’t his job to listen to my life story- but it left me feeling guilty and afraid. The most embarrassing part was his subsequent refusal to refill my prescription.

Based on the research I’d done I had a hard time understanding his reaction. There are risks associated with taking antidepressants during pregnancy but that risk is thought to be minimal. After having suffered through years of untreated depression, I knew what the risks would be if I stopped taking my medication.

A week after the initial doctor’s visit, I went to see my OBGYN. When I posed the same question to her she waved her hand at me and said, “Stay on you medication.” I started down my list of questions regarding the risks. She listened for a bit and then stopped me. She told me that there were risks no matter which decision I made but that she highly recommended that I continue to treat my depression.

That’s exactly what I did. I had plenty of fears about the possibility that the antidepressants might harm my baby, but I was more afraid of what might happen to both of us if I stopped taking them. I was afraid that halfway through the pregnancy I would end up a non-functioning, emotionally irrational, suicidal wreck. My fears were based on hard won experience.

I was also terrified that if I allowed myself to regress to this state I would not be able to care for my child once she was born. In retrospect I think that my decision to stay mentally healthy was most heavily influenced by my instinct to stay healthy for my baby.

It was a difficult decision but I am infinitely grateful that I chose to continue to treat my illness during my pregnancy. My baby is healthy and happy. Thankfully, I am in pretty good shape as well and am able to be an attentive and nurturing mother. I’ve said it before and it is worth repeating- I shudder to think where I’d be if I had made the decision to stop treating my illness.

It was the best decision for me, but I would never assume that it is the best decision for everyone suffering from depression. I think that I had to follow my instincts and not let guilt or social pressure influence me as I weighed my options. I had to stick to the facts.

For more information from actual professionals do a quick web-search on the topic. There is a plethora of helpful information out there.

I’ve been thinking a good bit this weekend about the issue of “forcing” treatment upon mentally ill people, particularly those who are in immediate and ongoing danger of being hurt by their illness, or at risk of causing others to be hurt. OK, I confess–“Grizzly Man” is playing on cable this weekend, and Treadwell‘s story rips at my heart, because when you watch the footage of him, he is so obviously ill. Brilliant, creative, with a big heart…but sick. He was diagnosed with bipolar disorder and other things, but always refused treatment, and, I feel, ultimately died as a result of that refusal.

Have you heard or read about “Kendra’s Law?” If not, go check out this story, and see what you think. I’m really interested in hearing others’ thoughts on this topic. When I hear the term “forced treatment,” my mind immediately conjures up images from Ken Kesey’s novel “One Flew Over The Cuckoo’s Nest”, and Jack Nicholson’s consequent film portrayal of its main character, who has “treatment” forced on him right up through lobotomy. But from what I can see right now, it apears that the goal of Kendra’s Law is just about the opposite of the nightmare created in”Cuckoo’s Nest.” It’s not about institutionalizing people, locking them up and keeping them in chemical straitjackets. It seems to seek to help people live connected, fulfilling, and maybe ironically, independent lives.

Consider the very nature of disorders like bipolar disorder and schizophrenia…they deny their own existence. That is actually a diagnostic criteria sometimes, which boggles my mind: “Oh, you don’t think you’re sick? Well, that PROVES you are.” Yikes! But in bipolar support groups, I have seen more heartache than I can stand to reflect on much, coming simply from the sick person’s lack of insight. I don’t really even like that term, “insight,” because it implies something you can choose to have, and for many mentally ill people, that choice just does not exist without medication. And to complete the catch-22, without insight, medication is never going to be chosen. So there you are, stuck in a truly vicious cycle. I’m not talking about people who don’t like meds, resent having to take meds, etc. I mean the greater-than-80% of affected people who cannot recognize that they have an illness. If you could, somehow, get proper medication into these people, then they would be able to achieve the insight they would need to recognize the need for the medication…see the problem, here?

So, what say you all? At what point do we have the right to step in and mandate that someone else take medication–of any kind? Do we wait until they’re harming themselves and/or others? That seems to be what happens currently, and results in involuntary commitments…what if we could get to the problem and treat it before someone had to crash hard, possibly taking other people down with them? And at what point do “we” step in? I’m wondering how you get a diagnosis on someone who is totally non-compliant in the first place. Seems like someone would have to have run up against “the system” at least once, resulting in, at the very minimum, a 72-hour hold, in order to be diagnosed with a mental illness. I can easily see a “slippery slope” argument here, too. If we can mandate treatment for one thing, then why not another, and another, until we’ve reached Brave New World status?

But then, I see so many people homeless, sick, miserable, addicted to drugs and/or alcohol, having lost everything…when just straightening out some brain chemistry might have given them completely different lives, if only.

It’s a good topic for discussion, and I’m going to be doing some more research into Kendra’s Law, to try and figure out the details. I don’t know what kind of “teeth” it has, or what the consequences are for non-compliance, or what criteria must be met to have it put into play. I thank God regularly that my husband is one of the “lucky” ones (Yeah, I know–funny, huh? Ha, ha.) who doesn’t have any compliance issues…but you know what? When he was undiagnosed, unmedicated, and unstable? He didn’t HAVE any insight, wasn’t capable of recognizing his illness. He had to first “hit bottom,” and be involuntarily hospitalized and medicated first. Even then, he was not initially treated correctly in the beginning, and suffered a relapse, and yet another involuntary hospitalization. That was the one that saved his life, and he’s been pretty stable for almost 4 years now. And I have to ask myself, is what he went through back then really that different from what Kendra’s Law proposes? The only real difference I can see is that once my husband was released from the hospital, there was nothing in place to ensure that he kept taking his meds–he was free to get off them and start cycling again at any time, as he is now. Fortunately, he doesn’t misinterpret “feeling better” with “being well.” But he’s not in the majority there.

If you have someone in your life who suffers from a mental illness, but who can’t recognize that fact, and it drives you to distraction, there are two sources I strongly recommend, both from Dr. Xavier Amador. One is his fantastic book, “I Am Not Sick; I Don’t Need Help,” and the other is this amazing lecture on the topic of anosognosia (lack of insight). This video can honestly change the way you look at mental illness, and in my opinion, applies in good measure to addiction, as well. Amador is inspirational, and speaks not only as a healthcare professional, but as the loving brother of a schizophrenic who refuses treatment. Do yourself a favor and block off a couple hours of time to view this lecture. Heck, even if you have to view it in 15-minute chunks here and there, it is SO worth your time.

I think about that cutesy image used to explain codependency from in the early 1990s that was so popular; the family as a mobile. We’re all strung by bits of thin white thread, dangling from bent wires. One of us moves and we all move, wobbling, swaying, affected. Spinning, spinning.

I make the mobile spin all the time these days, because I’m the one who says things out loud. I’m the complainer, the party pooper, the black sheep. I’m the crazy one. And that’s something I’m trying to embrace.

Losing my thin veneer of sanity and working with my therapist has given me a voice, and that’s scary. It’s scary for me and it’s scary for my family. I’m the one who says “Are you drunk? Don’t call me when you’re drunk. Don’t accuse me of things, because you’re in blackout mode.” And then I pretend saying it out loud didn’t scare the hell out of me. I’m the one who says, “You’re not going to throw a tantrum. You’re not going to scare the children. You need to be in control or you need to leave.” And then I pretend to not look for the best exit.

Pretending that things weren’t happening was their way of dealing with the madness, and witnessing – acknowledging – that things ARE happening is my way of dealing with the madness. It’s different this time, because I’m an adult and can and do protect myself. I can and do protect my children. Let them label me a bitch, a grump, an over-reactor. It’s different this time.

I like the mobile image, and I also dismiss it. If you are part of the mobile, you have no choice in when and how you move. Are moved. And while the others do affect me, still, I have decided they no longer will make me wobble and spin.